The most requested factors in clinical skills exams for evaluating novice physicians: an internet-based survey of the general public in Japan

Junji Otaki, Shizuko Nagata-Kobayashi, Ayumi Takayashiki, Maiko Ono, Motoharu Fukushi, Shinji Matsumura

BACKGROUND: Clinical skills tests have been added to the national medical licensure examinations in Canada, the U.S., Korea and Switzerland. Adding a clinical skills test to the Japanese national medical licensure examination should also be considered under the Medical Practitioners Act. On the other hand, such tests might be costly and represent an economic burden to the nation's citizens. Thus, it is appropriate to obtain the opinion of the general public for the introduction of such tests. Although a clinical skills test can measure various competencies, it remains uncertain as to what should be measured. In this study, we aimed to ascertain public opinion regarding the clinical skills demanded of novice physicians. METHODS: We conducted an internet-based survey of the general public in Japan. We randomly selected 7,213 people aged 20 to 69 years. The main topics surveyed included: whether the Japanese government should add a skills test to the existing national medical licensure examination; what kind of skills should be included in this test; and who should pay for the examination. RESULTS: Of 3,093 (1,531 men and 1,562 women) people who completed the questionnaire (completion rate 42.9%), 90.5% (n = 2,800) responded that a clinical skills test should be part of the national medical licensure examination. The main skills which respondents thought should be included were "explaining and discussing medical issues in an appropriate manner to patients" (n = 2,176, 70.4%), "accurately diagnosing problems by conducting a physical examination" (n = 1,984, 64.1%), and "carefully interviewing patients to make a diagnosis" (n = 1,663; 53.8%). Three-fifths of the respondents (n = 1,900; 61.4%) responded that more than half of the cost of the examination should be paid by the Japanese government. CONCLUSIONS: The majority of respondents indicated that a clinical skills test should be added to the national medical licensure examination. These respondents who represent the general public were requesting the verification of communication, diagnostic interview and diagnostic physical examination skills. Medical educators should incorporate these public requests, and teach and assess medical students accordingly.